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Tireh H, Heidarian Miri H, Khajavian N, Samiei A, Afzalaghaee M. Prevalence of Diabetes Mellitus and its Related Factors in Patients with Tuberculosis. ARCHIVES OF IRANIAN MEDICINE 2022; 25:835-840. [PMID: 37543911 PMCID: PMC10685843 DOI: 10.34172/aim.2022.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/11/2021] [Indexed: 08/08/2023]
Abstract
BACKGROUND Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. METHODS In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. RESULTS The mean age of participants was 51.14±20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR=3.786 (1.183, 12.113), body mass index with OR=9.149 (3.182, 26.302), nationality with OR=2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. CONCLUSION The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality.
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Affiliation(s)
- Hossein Tireh
- Student Research Committee, Mashhad University of Medical Science, Mashhad, Iran
| | - Hamid Heidarian Miri
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasim Khajavian
- Instructor Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Amin Samiei
- Tuberculosis Coordinator at Health Department of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavar Afzalaghaee
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Byashalira KC, Chamba NG, Alkabab Y, Mbelele PM, Ntinginya NE, Ramaiya KL, Alimohamed MZ, Heysell SK, Mmbaga BT, Bygbjerg IC, Christensen DL, Mpagama SG, Lillebaek T. Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania. BMC Infect Dis 2022; 22:260. [PMID: 35296241 PMCID: PMC8925287 DOI: 10.1186/s12879-022-07249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers. Methods Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol. Results Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia. Conclusion The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.
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Affiliation(s)
- Kenneth Cleophace Byashalira
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania. .,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania.
| | - Nyasatu Godfrey Chamba
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Peter Masunga Mbelele
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Nyanda Elias Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | | | - Mohamed Zahir Alimohamed
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Scott Kirkland Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Ib Christian Bygbjerg
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Lund Christensen
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah George Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Troels Lillebaek
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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Alebel A, Wondemagegn AT, Tesema C, Kibret GD, Wagnew F, Petrucka P, Arora A, Ayele AD, Alemayehu M, Eshetie S. Prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2019; 19:254. [PMID: 30866836 PMCID: PMC6417234 DOI: 10.1186/s12879-019-3892-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 03/07/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tuberculosis and diabetes mellitus are significant global public health challenges. In Sub-Saharan Africa, study findings regarding prevalence of diabetes mellitus amongst tuberculosis patients have been inconsistent and highly variable. Therefore, this systematic review and meta-analysis estimates the overall prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa. METHODS Four international databases (PubMed, Google Scholar, Science Direct and Cochrane Library) were systematically searched. We included all observational studies reporting the prevalence of DM among TB patients in Sub-Saharan Africa. All necessary data for this review were extracted using a standardized data extraction format by two authors (CT and AA1). STATA Version 14 statistical software was employed to conduct meta-analysis. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of diabetes mellitus in TB patients. Besides, subgroup analysis was done based on different factors. RESULTS In the meta-analysis, sixteen studies fulfilled the inclusion criteria and were included. The findings of these 16 studies revealed that the pooled prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was 9.0% (95% CI: 6.0, 12.0%). The highest prevalence of diabetes mellitus among tuberculosis patients was found in Nigeria (15%), followed by Tanzania (11%), and then Ethiopia (10%). Besides, the prevalence of diabetes mellitus among HIV infected TB patients was (8.9%) which is slightly higher than HIV uninfected (7.7%) TB patients. CONCLUSION Diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was significantly high. Moreover, this study found that there was a high prevalence of DM among HIV infected than uninfected TB patients. It is strongly recommended to screen for DM among TB patients and special emphasis should be given for early screening of DM among TB/HIV co-infected patients.
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Affiliation(s)
- Animut Alebel
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | - Cheru Tesema
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Fasil Wagnew
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145 Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
| | - Amare Demsie Ayele
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Alemayehu
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Setegn Eshetie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLoS One 2017; 12:e0175925. [PMID: 28430796 PMCID: PMC5400500 DOI: 10.1371/journal.pone.0175925] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health concern. There is mounting evidence from different countries on the burden of TB and DM comorbidity. The objective of this systematic review was to summarize the existing evidence on prevalence and associated/risk factors of TBDM comorbidity at global and regional levels. Methods Ovid Medline, Embase, Global health, Cochrane library, Web of science and Scopus Elsevier databases were searched to identify eligible articles for the systematic review. Data were extracted using standardized excel form and pilot tested. Median with interquartile range (IQR) was used to estimate prevalence of TBDM comorbidity. Associated/risk factors that were identified from individual studies were thematically analyzed and described. Results The prevalence of DM among TB patients ranged from 1.9% to 45%. The overall median global prevalence was 16% (IQR 9.0%-25.3%) Similarly, the prevalence of TB among DM patients ranged from 0.38% to 14% and the overall median global prevalence was 4.1% (IQR 1.8%-6.2%). The highest prevalence of DM among TB patients is observed in the studied countries of Asia, North America and Oceania. On the contrary, the prevalence of TB among DM patients is low globally, but relatively higher in the studied countries of Asia and the African continents. Sex, older age, urban residence, tobacco smoking, sedentary lifestyle, poor glycemic control, having family history of DM and TB illness were among the variables identified as associated/risk factors for TBDM comorbidity. Conclusion This systematic review revealed that there is a high burden of DM among TB patients at global level. On the contrary, the global prevalence of TB among DM patients is low. Assessing the magnitude and risk/associated factors of TBDM comorbidity at country/local level is crucial before making decisions to undertake TBDM integrated services.
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Affiliation(s)
- Mahteme Haile Workneh
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- * E-mail:
| | - Gunnar Aksel Bjune
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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